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Health Care Systems

Community Based Nursing

Patty Averre

on 24 October 2014

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Transcript of Health Care Systems

Emphasis on Cost Containment
Advancements in Technology
Knowledge Explosion
Expanded use of Alternative Therapies
Demographic Shifts
Current Trends in Home Care
Higher acuity needs
Caregivers unskilled
Strained resources
Typically long term assistance needs….....caregiver strain and fatigue
Caregiver Support
 Skilled nursing intervention needs
 Collaboration with referring MD and patient
 Documentation of progress

A home health nurse is discussing the need to use a specific cleansing agent when redressing an infected hand. The client prefers using “plain old soap and water.” The nurse knows the primary factor that will affect client compliance is:
A. The ease of using the special cleansing agent
B. The client’s acceptance of needing the specialized care
C. The availability and cost of the new cleansing agent
D. The introduction of an incentive to motivate client compliance
Ongoing: compliance and homebound status
New assessment findings
Determine perceived progress
Documentation of progression towards endpoint and termination of visits
The Home Visit
Self-care abilities
Continuity of care
Knowledge base and learning needs
Physical Assessment
Environmental Assessment
Caregiver Assessment
The Home Visit
Medicare 32%
Require a skilled intervention
Under the care of a physician
Home Care Agency must be Medicare certified

Payment for Home Care
Provides health services to individuals and families in their places of residence for the purpose of promoting, maintaining and restoring health.

Home Health Nursing
International Health Organizations
Federal Health Agencies
State Health Departments
Local Health Departments
Private Funding
Health care financing
To facilitate change within a community, the nurse working as an effective change agent should:
A. Inform community members how to effectively manage their health needs
B. Work with clients and groups to select alternative health care sites and treatments
C. Formulate decisions for individual clients regarding their health care options
D. Provide instruction in the way the community should address health issues
Clicker ?

Access to health care
Screen children 6 months to 5 years old for blood lead levels
Obtain environmental health histories of individuals
Advocate for safe air and water
Educate asthmatic clients about environmental triggers
Support programs for waste reduction and recycling
Survey for health conditions that may be related to environmental and occupational exposures

Primary Prevention
Secondary Prevention
Tertiary Prevention
Levels of Disease Prevention
Health Promotion and Disease Prevention:
Healthy People 2020
Home Health Care
Occupational Health
School Nurses
Parish Nursing
Case Managers
Roles and Settings for
Community-Based Nurses

What might be some
Ethical & Legal Concerns in
Community-Based Nursing?
Community-Based Nursing Competencies
Public Health Nursing
Community Health Nursing

Community Based***
Community Oriented
Types of Nursing
NUR 212
Ms. Averre
Module: Health Care Systems
Part B
Community-Based Nursing
Know the community
Dress sensibly
Evaluate safety and avoid early or late visits
Follow agency policies and procedures
Keep supervisor informed of potentially unsafe situations
Phone, flashlight, and car maintenance
Safety for the Nurse
Plan of Care
Discuss needs and collaborate on plan
Determine the role/responsibilities of the caregiver between visits
Plan desired outcomes promoting self-care
The Home Visit
Introductions/Casual conversation
Outline purpose of the visit
The Home Visit

When assessing members of a vulnerable population, the community health nurse should realize that the primary need is to:
A. Provide culturally competent assessment
B. Organize in your mind exactly what you need to ask
C. Create a comfortable, nonthreatening environment
D. Be alert for indications of mental and physical abuse
Clicker ?
A nurse is planning interventions for the clients of a homeless shelter. Which of the activities represents a primary level intervention regarding STDs?
A. HIV screening for all residents
B. Sex education for teenage residents
C. Treatment for residents diagnosed with AIDS
D. Gynecological referrals for female residents
Clicker ?
Which one of the following clients from a vulnerable population currently appears to be at the greatest risk?
A. A physically abused client in a shelter
B. A schizophrenic client in outpatient therapy
C. An older adult taking medication for HTN
D. A substance abuser who shares drug paraphernalia
Clicker ?
Promote, preserve, and maintain health
Impact whole community
Disease and disability prevention
Community Health Nursing Practice***
Public Health Nursing Practice
Nursing Theories
Clicker ?
Focus of care:

individuals & families
Illness care:
Management of acute and chronic conditions
Promote, preserve, and maintain health
Impact whole community
Delivery of health services to individuals, families, & groups
Focus of care:
at-risk individuals, families, & groups and the community
Health care:
Determine health needs and intervene to improve collective health

Physical Care-giving
Critical Thinking
Primary, Secondary, or Tertiary Prevention?
Community Oriented Nursing
Community Based Nursing

Support cleanup of toxic waste sites and removal of other hazards
Refer homeowners to lead abatement resources
Educate groups to reduce environmental hazards
Monitor workers for levels of exposure at job sites
Assess homes, schools, work sites, and the community for environmental hazards

Prevention services provided by nurses in community based settings play a critical role in minimizing the impact of chronic conditions in America.

Factors Influencing Community Health:
1. Family and culture
2. Social and environmental factors
3. Access to health care
4. Health care financing

Family and Culture
Cultural assessment
Cultural competence

Transcultural Nursing Competencies
 Avoid Cultural Blindness
 Avoid Ethnocentrism
Develop Cultural Awareness
 Develop Cultural Knowledge
 Develop Cultural Competency
Social and environmental factors
Environmental assessment
Individual and community interventions
The Home Visit
Chronic diseases:
Epidemiological Triangle:

- the object that causes the disease

- the living being that is affected by the agent
- the setting that sustains the host

National health goals to address for vulnerable populations include:

Increasing the number of people who have a routine primary care provider◯
Increasing the number of people with health insurance◯
Reducing the number of people who are unable or have a delay in accessing health care services and prescribed medications
A nurse is caring for a client who is from a different culture. When beginning the cultural assessment, which of the following actions should the nurse take first?
A. Determine the client’s perception of his current health status.
B. Gather data about the client’s cultural beliefs.
C. Determine how the client’s culture may impact the effectiveness of nursing actions.
D. Gather information about previous client interactions with the health care system.

A nurse manager at a community agency is developing an orientation program for newly hired nurses. When discussing the differences between community-based and community–oriented nursing, the nurse should include which of the following as examples of community-based nursing? (Select all that apply.)

a. A home health nurse performing wound care for a client who is immobile.
b. An occupational health nurse providing classes on body mechanics at a local industrial plant.
c. A school nurse teaching a student who has asthma about medications.
d. A parish nurse teaching a class on low-sodium cooking techniques.
e. A mental health nurse discussing stress management techniques

Clicker ?
A nurse at an urban community health agency is developing an education program for city leaders about homelessness. Which of the following should the nurse include as the fastest-growing segment of the homeless population?

A. Families with children
B. Adolescent runaways
C. Intimate partner abuse victims
D. Older adults

Clicker ?
A nurse is preparing an education program on disease transmission for employees at a local day care facility. When discussing the epidemiological triangle, the nurse should include which of the following as agents? (Select all that apply.)

a. Resource availability
b. Ethnicity
c. Toxins
d. Bacteria
e. Altered immunity
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